Preventing Self-harm in Teens: A Guide for Appropriate Intervention
By Zocdoc |
Medically reviewed by Dr. Nassim Assefi
Teens have the highest rate of self-harm among any age demographic, with approximately 17% of teens reporting at least one instance of self-harm in their lifetime. The average age of the first incident of self-harm is 13. Often teens will seek out support from loved ones rather than mental health professionals. However, many teens will take extraordinary steps to conceal their self-harm, or even deny engaging in such behavior.
Additionally, they may not even be aware of what professional resources are available to them. As such, it is important for anyone with a teen in their life to be aware of warning signs and understand how to appropriately address instances of self-harm.
Why do teens self-harm?
There is not any single reason that teens engage in self-harm. However, there are a few common factors. Notably, many teens who engage in self-harm do so because they are grappling with difficult emotions that they are unable to healthily manage. Self-harm may provide such teens with a feeling of distraction or release, or may be a means of acting out frustration. Additionally, in some cases, teens may self-harm as a means of demonstrating their pain or stress to prompt help from others. Many risk factors may increase the likelihood of self-harming behaviors, such as mental illness, stress or traumatic experiences.
What is considered self-harm?
Self-harm can be carried out through many different means. Virtually any act in which someone intentionally causes harm to themselves can be considered self-harm. Some acts that can be considered self-harm include:
Cutting yourself
Punching yourself
Punching other objects
Slapping yourself
Burning yourself
Pulling out your hair
Pinching yourself
Poking yourself with sharp objects
Breaking bones
Additionally, all types of self-harm fall under one of two categories: suicidal self-injury and non-suicidal self-injury. Self-harm may co-occur with suicidal ideation and even suicide attempts, but they are not interchangeable. Many different factors can lead to either behavior, although prolonged self-harm can put teens at a higher risk of accidental suicide. Suicidal self-injury is self-harm where the individual is acting with the intention of ending their life or self-harm that is occurring alongside suicidal ideation or suicidal behaviors. All instances of self-harm should be taken seriously and met with immediate intervention, but in the case of suicidal self-harm in particular there must be no delay in life-saving response efforts.
Potential signs of self-harm
Someone who is engaging in self-harm can exhibit a wide range of further warning signs. Such warning signs can include:
Visible injuries: This is particularly concerning if the person has consistent injuries that do not appear accidental — they may even be found on the same area of the body. This may include injuries such as cuts, burns and bruises.
Constantly wearing clothes that cover the skin: This is particularly concerning if the individual wears such clothing even when it is inappropriate for the weather or situation. This may include attire such as long pants, long sleeves and scarves.
Unusual reactions: The individual may react strangely to various situations, e.g. becoming highly defensive for no obvious reason. They may also demonstrate unusual or sudden changes in mood, body language, or reactions to physical touch.
Various signs of underlying mental illness: In many cases of self-harm, mental illness is a contributing factor. As such, in many cases, warning signs for self-harm will be the same as warning signs for underlying mental illnesses, e.g. loss of interest in previously loved activities in the case of depression.
However, it is important to keep in mind that warning signs may be highly subtle or virtually non-existent. As such, families and educators need to stay highly engaged with the teens that they are responsible for and check in with them regularly about their well-being.
Underlying conditions
As mentioned, in many cases underlying mental illness is the cause of self-harm or a significant exacerbating factor. Many types of mental illness and other underlying conditions or neurodivergent behaviors can contribute to self-harming behaviors. This can include the following conditions:
Depression: This disorder is characterized by low mood, reduced energy, and loss of interest.
PTSD: This is a disorder characterized by anxiety and flashbacks that are caused by experiencing a traumatic event.
Bipolar disorder: Bipolar is a mood disorder that is characterized by drastic shifts in mood and sometimes elements of psychosis.
Anxiety: Anxiety is characterized by persistent stress that is not proportional to the person’s current experiences.
Compulsive behaviors: Compulsive behaviors are characterized by an urge to repetitively engage in actions in an attempt to cope with stress. These behaviors can be caused by a variety of underlying disorders.
Schizophrenia: Schizophrenia is a disorder characterized by psychosis and impulsive behaviors.
Substance abuse: Substance abuse is the use of various substances in a way that is harmful or self-destructive.
Various chronic health conditions: Chronic health conditions can be painful, disruptive or stressful.
If an underlying condition is contributing to self-harm, it is important to address these underlying concerns to successfully treat the self-harm.
Contributing experiences
There are many life experiences that can increase a person’s risk of developing self-harming behaviors, including:
Abuse
Loss of a loved one
Divorce of guardians
Moving homes
Bullying
Unhealthy behaviors modeled by family and friends
Financial hardships
Discrimination
Feelings of shame
It is important to bear in mind that teens typically have not developed the mental and emotional skills that adults have, and therefore guardians and educators should check in with a teen who is experiencing significant change or a stressful event.
Long-term risks of untreated self-harming behaviors
Self-harm behaviors may emerge as a coping mechanism, but can evolve through repetition into a compulsive behavior. This can manifest similarly to any other addiction in the developing brains of teens, and prevent them from exploring or properly learning other, healthier coping skills for stress and other negative emotions.
Non-suicidal self-harm can also become harder to judge or control, as it becomes more familiar and habitual. This can lead to a greater risk of serious injury, or even life-threatening escalation of the self-harm methods used. It is also possible for the damage inflicted to grow worse, fail to heal properly, or create more profound and lasting damage if the behavior does not stop.
Socially, it is common for self-harm to be concealed and kept secret, which can further inhibit appropriate coping skills and support networks from being used or even recognized. Again, similarly to the behavior of other individuals suffering from addiction, shame spirals and withdrawing from healthy relationships can become more likely when someone is trying to hide their self-harm habits.
Strategies for loved ones
A teen that is engaging in self-harming behaviors needs the support of their loved ones, particularly the adults in their lives. It can be difficult to know how to navigate helping a teen who is experiencing such difficulties. However, the following are some strategies that are often a good place to start:
Deal with your feelings about the situation in a healthy way. If you do not do this, it can negatively impact your ability to help the teen in your life.
Do thorough research and consider consulting a professional.
Do not make the teen in your life feel ashamed about the situation or their underlying conditions.
Consider confiding in a select few other people in the teen’s life that may be able to provide further support.
Do not widely share the information as a lack of privacy may result in further stress.
Prioritize consent. If the teen feels like they are losing control over the situation, it could exacerbate the problem.
Broach the topic in a sensitive, considerate manner that makes the teen feel safe and supported.
Avoid exhibiting negative emotions such as fear, anger or disgust, and if you do feel any of those feelings, keep them private and work to manage them on your own time.
Seek out further resources that can help you support the teen. It is important to keep in mind that while the support of loved ones is extremely valuable, they cannot effectively fill the role of a therapist or other mental health professional.
Ensure that any further support you enlist is highly reputable and has specialized skills and tools to navigate such a situation.
Treatments for self-harm
Ideally, treatment for self-harm should start with intervention and evaluation with a licensed psychologist. Going forward, this professional can help the individual develop a combination of treatments that suits their unique needs. Treatments for self-harm can include the following:
Psychological evaluation: A psychological evaluation should be the first step in treating self-harm behaviors. This evaluation will determine what the underlying causes are and what treatment options may be most useful going forward.
Cognitive behavioral therapy (CBT): This is a type of talk therapy conducted by a licensed psychiatrist or licensed therapist that is aimed at understanding and managing behaviors.
Dialectical behavioral therapy (DBT): This is a type of CBT that is focused on emotional regulation. The main goals of this type of therapy are to teach people how to live in the moment, cope with stress and improve relationships with themselves and others.
Alternative therapy options: There are many alternative therapeutic outlets that people may benefit from, such as wilderness therapy and creative expression. While these can be beneficial, it is important to pursue them in conjunction with more traditional forms of therapy rather than in place of it.
Medical intervention: In some cases, medication may be a vital component of effective treatment. This can be prescribed by a doctor or a local licensed psychologist. Prescription of medication may occur during the psychological evaluation process.
You must research the background and specializations of any professionals that you plan to work with to ensure that you are on the same page and they are properly qualified.
Utilizing school support systems
Many school systems and individual schools have various support systems in place to support struggling students. This can be a valuable resource for a teenager who is engaging in self-harm behaviors. These resources may be particularly valuable for students who have limited social support at home, financial limitations, or need relatively constant support in different areas of their lives. Resources provided by schools may include things such as guidance counselors, support groups, and various services.